13 Harrod Street 1-4-18 —�, 1100 Crown Colony Drive
P.O. Box 699103
Quincy,MA 02269-9103
A R B E L LA 617.328.2800
INSURANCE GROUP arbella.com
January 19, 2018 Rr-CEIVED
SALEM BUILDING COMMISSIONER JAN 2 2 2018
SALEM CITY HALL CITY OF SALEM
93 WASHINGTON STREET BOARD OF HEALTH
SALEM, MA 01970
Claim Number: 033895113
Policy Number: 43192400004
Company Name: Arbella Mutual Insurance Company
Date of Loss: 01/04/2018
Insured: MANUEL RAYMOND
Property Location: 13 HARROD STREET, SALEM, MA
Dear Sir/Madam:
A claim has been made involving loss, damage, or destruction of the above captioned property, which
may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be
applicable.
If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate, please direct it
to the attention of the writer. Please include a reference to the captioned insured, location, date of loss
and claim number.
Thank you for your assistance.
Sincerely,
Emily Migre
Claim Service Specialist
Property Claim Office
800-272-3552 ext. 7369
Fax 617-773-4760
CC: SALEM HEALTH DEPARTMENT
SALEM CITY HALL
93 WASHINGTON STREET
SALEM, MA 01970
CC: SALEM FIRE DEPARTMENT
48 LAFAYETTE STREET
SALEM, MA 01970